Median atlantoaxial joint

[properexercise]

Is it possible to inject the median atlantoaxial joint (articulation of odontoid process and C1)?

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[Baron Samedi]

There is no body cavity that cannot be reached with a #14 needle and a good strong arm.

 

[lobelsteve]

There is no body cavity that cannot be reached with a #14 needle and a good strong arm.

Thanks Shem.

 

[Orin]

Is it possible to inject the median atlantoaxial joint (articulation of odontoid process and C1)?

Minimally Invasive Atlanto-Odontoid Joint Injection for Involvement in Rheumatoid Arthritis: A Case Report and Technical Note
Do you mean like this?

 

[bedrock]

Minimally Invasive Atlanto-Odontoid Joint Injection for Involvement in Rheumatoid Arthritis: A Case Report and Technical Note
Do you mean like this?

Damn.

Definitely not something I’d try.

 

[properexercise]

Minimally Invasive Atlanto-Odontoid Joint Injection for Involvement in Rheumatoid Arthritis: A Case Report and Technical Note
Do you mean like this?

Through the mouth intra-articular?

 

[lobelsteve]

Through the mouth intra-articular?

A case report was presented. I do not know anyone who would ever perform this injection, and I certainly wouldn’t allow it to be performed on anybody I knew.

 

[Orin]

Through the mouth intra-articular?

Well technically not through the mouth but submandibular, although that might be the simplest way to access anterior elements that high up. Like a C2 kypho (Kyphoplasty of C2 Pathological Fractures Using an Anterior Midline Approach and Steerable Osteotome: Technical Note and Case Series - PubMed)

 

[properexercise]

A case report was presented. I do not know anyone who would ever perform this injection, and I certainly wouldn’t allow it to be performed on anybody I knew.

Why? If someone you knew went to the Regenexx headquarters in Colorado to get the injection, how would you stop him?

 

[Orin]

Why? If someone you knew went to the Regenexx headquarters in Colorado to get the injection, how would you stop him?

I would counsel them that it is a rare injection that is done very infrequently because it carries a great deal of risk. The margin for error is very small there in that high value real-estate and if I had to have it done, I would have it done by someone with a CT scanner/O-arm while I was under general anesthesia so I didn't move. I would ask them if having a stroke or dying is an acceptable risk for them for something that may only provide hours to days of relief.

With that said, if it works, there are people that do endoscopic or open inflammatory pannus removal/fusions of that area, so it might be a reasonable thing to attempt before the bigger surgery, Changes in retro-odontoid mass after upper cervical spine surgery - Scientific Reports. That's more reasonable for the neurologic compression/paralysis issue than the pain issue, but still, it depends where they are on the algorithm

People get desperate, so I try to remind them it's not a good idea to make decisions from that position, and then try to medicate them to temporize while avoiding craziness. If they want to go crazy, then I try really hard to find the best person to do that for them.

 

[RoloTomassi]

Why? If someone you knew went to the Regenexx headquarters in Colorado to get the injection, how would you stop him?

By explaining to them as the article says:

Risks from the procedure include puncture of the ipsilateral carotid arteries and bacterial contamination from perforation through the oropharyngeal mucosa, which then can establish an infective arthritis of the atlanto-odontoid joint with ensuing complications of osteomyelitis or epidural abscess.

... weighed against zero data for potential benefit

 

[properexercise]

By explaining to them as the article says:

Risks from the procedure include puncture of the ipsilateral carotid arteries and bacterial contamination from perforation through the oropharyngeal mucosa, which then can establish an infective arthritis of the atlanto-odontoid joint with ensuing complications of osteomyelitis or epidural abscess.

... weighed against zero data for potential benefit

There is certainly a significant body of data supportive of PRP and BMAC for use in other joints. Are we to wait for data to the standard required for FDA approval for each of about 360 joints in the body before we consider using them anywhere that may need them? Thousands of years of clinical trials? And are we to ignore the risks of inaction (certain worsening, dependence on analgesics, a disabling upper cervical fusion)? Why aren’t physicians more interested in developing these procedures?

 

[MitchLevi]

There is data supportive of PRP and BMAC for use in other joints. Are we to wait for data to the standard required for FDA approval for each of 360 joints in the body before we consider using them in any joint in which they may be needed? Thousands of years of clinical trials? And are we not to weigh the risks of inaction (certain worsening, dependence on analgesics, a disabling upper cervical fusion)? Why aren’t physicians more interested in developing these procedures?

Welcome to the forum.

Post more...Modern healthcare needs more trailblazers and you may be that dude.

 

[Taus]

There is data supportive of PRP and BMAC for use in other joints. Are we to wait for data to the standard required for FDA approval for each of 360 joints in the body before we consider using them in any joint in which they may be needed? Thousands of years of clinical trials? And are we not to weigh the risks of inaction (certain worsening, dependence on analgesics, a disabling upper cervical fusion)? Why aren’t physicians more interested in developing these procedures?

So you’re saying you would let someone do this procedure at C1-C2 to your mother?

 

[MitchLevi]

So you’re saying you would let someone do this procedure at C1-C2 to your mother?

Certainly no...Let a few other mothers have it done, and when a few of them DIE or become PARALYZED (a very legitimate concern here), the questions we all wanted to ask will have been answered and we can move on to something else.

 

[RoloTomassi]

And are we not to weigh the risks of inaction (certain worsening, dependence on analgesics, a disabling upper cervical fusion)?

Disease course is not always as aggressive as you make it out to be. Plenty of people not requiring opioids or fusion.
Does PRP/BMAC help that much in progressive cases? What's the NNT to prevent a fusion? We don't even have an NNT for something as well studied as orthobiologics for knee OA. C1-2 is as unique of a joint as you can get, can't extrapolate all data to this joint.

Why aren’t physicians more interested in developing these procedures?

If you have the resources and liability protection to develop them, more power to you. Most of us don't have the luxury.

You seem very idealistic. Once you see more complications from cowboys and heroes you'll start to lean more conservative.

 

[Clean7795]

Through the mouth intra-articular?

They did it via oblique approach through the submandibular space and parapharyngeal fat plane in a sterile fashion (not through the mouth).

This was an experienced, ballsy neuro-IR who did this. I cannot imagine another type of specialist attempting this because you have to be very comfortable with CT neck/skull base soft tissue anatomy and regularly do soft tissue/bone procedures in the neck.

Why aren’t physicians more interested in developing these procedures?

It's extremely risky. Death and permanent disability are possibilities. Doctors are sued all the time; even in a low medicolegal risk country I can imagine a doctor being sued for this if there was any complication.

Aside from that, the pay for this procedure wouldn't be very good relative to the risk/effort, and on top of that only a very small pool of physicians (certain interventional specialists) could safely accomplish this.

 

[Ducttape]

There is data supportive of PRP and BMAC for use in other joints. Are we to wait for data to the standard required for FDA approval for each of 360 joints in the body before we consider using them in any joint in which they may be needed? Thousands of years of clinical trials? And are we not to weigh the risks of inaction (certain worsening, dependence on analgesics, a disabling upper cervical fusion)? Why aren’t physicians more interested in developing these procedures?

we are to await data from this specific injection for this specific joint.

otherwise you are giving snake oil and will kill someone in an unproven treatment.


i would be as remiss and as medically deficient by performing this injection as recommending someone get abducted by aliens and get @N@1 probing...


do no harm.

 

[MitchLevi]

we are to await data from this specific injection for this specific joint.

otherwise you are giving snake oil and will kill someone in an unproven treatment.


i would be as remiss and as medically deficient by performing this injection as recommending someone get abducted by aliens and get @N@1 probing...


do no harm.

Agree with most, but not all of this.

You need to prove to me getting probed carries some form of negative...anything.

I would argue the alternative - Alien probing is largely positive given the potential for monetization of the experience. You can get a book deal, go on History Channel, do a few podcasts...Print your own t-shirts too.

 

[Ducttape]

i can tell you that my experience - well, it was all a pile of 💩

 

[properexercise]

So you’re saying you would let someone do this procedure at C1-C2 to your mother?

If the physicians involved demonstrated a high level of conscientiousness over the long term, yes.

 

[properexercise]

Certainly no...Let a few other mothers have it done, and when a few of them DIE or become PARALYZED (a very legitimate concern here), the questions we all wanted to ask will have been answered and we can move on to something else.

You're saying a percutaneous injection procedure could not be as safe as an upper cervical fusion?

 

[properexercise]

we are to await data from this specific injection for this specific joint.

otherwise you are giving snake oil and will kill someone in an unproven treatment.


i would be as remiss and as medically deficient by performing this injection as recommending someone get abducted by aliens and get @N@1 probing...


do no harm.

I disagree with the hippocratic oath. The purpose of medicine is to ameliorate disease, not just avoid hurting people. We also need apply scientific standards to those throwing the term "snake oil" around. Where is the scientific evidence this ethos of medical conservativism is making people better off?

 

[properexercise]

They did it via oblique approach through the submandibular space and parapharyngeal fat plane in a sterile fashion (not through the mouth).

This was an experienced, ballsy neuro-IR who did this. I cannot imagine another type of specialist attempting this because you have to be very comfortable with CT neck/skull base soft tissue anatomy and regularly do soft tissue/bone procedures in the neck.



It's extremely risky. Death and permanent disability are possibilities. Doctors are sued all the time; even in a low medicolegal risk country I can imagine a doctor being sued for this if there was any complication.

Aside from that, the pay for this procedure wouldn't be very good relative to the risk/effort, and on top of that only a very small pool of physicians (certain interventional specialists) could safely accomplish this.

I did not read the case report thoroughly enough. Thank you for the insights.

 

[MitchLevi]

You're saying a percutaneous injection procedure could not be as safe as an upper cervical fusion?

Have a good day bro.

 

[Ducttape]

I disagree with the hippocratic oath. The purpose of medicine is to ameliorate disease, not just avoid hurting people. We also need apply scientific standards to those throwing the term "snake oil" around.

then maybe you should reconsider the choice of your career.

medicine is not about disease. it is about people. yes they may have a specific disease, but you are treating the person, not the disease.

We also need apply scientific standards to those throwing the term "snake oil" around. Where is the scientific evidence this ethos of medical conservativism is making people better off?

if you are postulating this, and are concerned, then please provide evidence that quackery and unproven medical treatments are beneficial to patients.

if you want a place to start, check out reflexology. or colon cleansing, or ear candling, or high dose oxygen therapy, or apple cider vinegar, or copper magnet therapy, or .......